Bartlett revenue cycle review moving ahead

Independent check intended to improve processes

The executive committee of Bartlett Regional Hospital’s board of directors cleared staff to negotiate a contract with a firm to conduct a revenue cycle review, which the hospital’s interim chief financial officer said is intended to identify “gaps” in the process and provide suggestions on how to improve it.

Dennis Stillman, Bartlett’s interim CFO, described the revenue cycle at Bartlett as a process by which each patient is admitted, charged and billed, among other steps. That process, he said, is not a perfect one.

“I can’t find any record that we’ve had anyone look at the whole system at once,” Stillman said.

Stillman presented to the committee a rundown of why he believes a revenue cycle review would benefit Bartlett, as well as some information on the hospital’s options.

“If you identify these problems, and they’re going to happen all the time, it takes our staff offline,” Stillman said. With an independent review conducted by an outside vendor, he added, “Somebody else will look at it and identify issues as opposed to taking our people offline.”

Among the potential pitfalls Bartlett deals with in its revenue cycles, Stillman identified such problems as getting the wrong insurance information at one stage in the process, or having medical records incorrectly coded.

Stillman said he expects that not all parts of the hospital’s operations will come out looking equal from the review.

“My guess is some of our areas will be relatively clean, and some areas won’t be,” Stillman said.

Two firms emerged as finalists to conduct the review, Stillman told the board, but he recommended the costlier option: Henderson, Tenn.-based Xtend Healthcare Advanced Revenue Solutions.

“I think the real plus with them is they have exposure in Alaska,” Stillman explained, saying it is also working in Sitka and Anchorage.

Board member Dr. Alex Malter, sitting in on the meeting, questioned the recommendation of Xtend over the less expensive option.

“Inasmuch as we’re trying to do things a bit more modestly … why not get the cheaper one?” Malter asked.

Stillman asserted that there is value to contracting with a vendor that knows the Northwestern – and specifically the Alaskan – health care market.

“How much importance is it? I don’t know, but I think there’s a benefit in knowing what the environment is here,” Stillman said.

Xtend’s estimate of $98,000 also included three additional days for a compliance review built into the cost, Stillman noted, while the other firm’s $79,500 estimate did not.

Linda Thomas, vice president of the board, said Xtend appealed to her as an option.

On a motion by Kristen Bomengen, the committee unanimously authorized the negotiation of a contract with Xtend in an amount not to exceed $110,000 plus travel expenses – building in an extra $12,000 in case more days are requested to complete the compliance review.

Stillman said the review is expected to be conducted by the end of the year, provided the contract is negotiated and then approved by the City and Borough of Juneau.

At the finance committee meeting immediately following the executive committee meeting, at which Stillman explained the revenue cycle in more detail, Malter asked why Bartlett has to bring in outside firms for matters like the revenue cycle review rather than simply hiring someone as staff to deal with them. He pointed to the Monday announcement of Ken Brough’s hiring as permanent CFO as an example.

“How ‘come we don’t hire a person who knows how to do this so we don’t have to bring in vendors and spend $100,000?” wondered Malter. “Why do we need to bring in outside experts to help us with this? Isn’t this what the financial leadership is supposed to be able to do in a normal hospital?”

Bartlett’s chief executive officer, Christine Harff, responded, “I have opinions and thoughts on why it has to be this complicated. I really wish it wasn’t, but unfortunately it is.”

Harff, for whom Tuesday’s meetings were her first public committee meetings at Bartlett, said many hospitals around the country have regular revenue cycle reviews conducted.

“It’s not uncommon for hospitals to do it every two to three years,” said Harff. “They just can’t do the work and keep up on all the regulation changes. … I would argue there’s not one hospital in this whole country that is doing everything compliant and perfect.”

Thomas added that having an external firm conduct a review may appear more credible, as well as provide an outside perspective.

“In private industry, oftentimes we pay for outsiders to come in and review, just to lend credibility to what our organization’s doing,” Thomas said. “Oftentimes it has value, because you learn how you can improve.”